Diagnosis

If your son has a testicle not located in the scrotum, his doctor will determine its location in the groin. Once it's located, the doctor will attempt to guide it gently into its proper position in the scrotum.

Your son may be lying down, sitting or standing during this examination. If your son is a toddler, the doctor might have him sit with the soles of his feet touching and knees to the sides. These positions make it easier to find and manipulate the testicle.

If the testicle is a retractile testicle, it will move relatively easily and painlessly. The retractile testicle won't immediately move up again.

If the testicle in the groin moves only partway into the scrotum, if the movement causes pain or discomfort, or if the testicle immediately retreats to its original location, it's most likely not a retractile testicle. The testicle would be considered undescended, or if the testicle had been in the scrotum at one time, it would be considered an ascending testicle.

Treatment

A retractile testicle is likely to descend on its own before or during puberty. If your son has a retractile testicle, your son's doctor will monitor any changes in the testicle's position in annual evaluations to determine if it stays in the scrotum, remains retractile or becomes an ascending testicle.

If the testicle has ascended — no longer movable by hand —your son's doctor will likely recommend surgery to move the testicle permanently into the scrotum. Also, if the testicle is still retractile during puberty, surgery will likely be recommended in the early teen years to ensure proper maturation of the testicle.

During this surgical procedure (orchiopexy), the surgeon frees the testicle and cord from any attached tissues, positions the testicle in the scrotum and stitches it into place.

After surgery, bicycle riding must be avoided and other sports activity limited for a couple of weeks. Follow-up exams to assess wound healing and the position of the testicle will be needed two weeks after surgery and again after six months.

Adolescent boys and men who have had treatments to correct an ascending or retractile testicle should regularly monitor the position of the testicle to ensure it doesn't ascend at a later time.

Although hormone treatments have been used to treat ascending testicles or retractile testicles in adolescents, the American Urology Association's 2014 guidelines no longer include this intervention because of a lack of evidence for successful response or long-term effectiveness.

Lifestyle and home remedies

You can help your son by being aware of the development of his body and talking to him about it.

  • Check the position of the testicles regularly during diaper changing or at bath time. Keep a record of any changes.
  • Give your son the vocabulary to talk about the scrotum and testicles. Explain that there are usually two testicles in the scrotum.
  • When he's about to reach puberty — usually around sixth grade — and you're talking about what physical changes to expect, explain how he can check his testicles.

Coping and support

If your son has a retractile testicle, he might be sensitive about his appearance. He might have anxieties about looking different from friends or classmates. To help your son cope:

  • Explain in simple terms what a retractile testicle is.
  • Remind him that there's nothing wrong with him.
  • Explain that the position of the testicle is something you, your son and his doctor will pay attention to and fix, if necessary.
  • Help him practice a response if he's teased or asked about the condition.
  • Buy loosefitting boxer shorts and swim trunks that might make the condition less noticeable when changing clothes and playing sports at school.
  • Be aware of signs of anxiety, such as not participating in sports that he would normally enjoy.

Preparing for your appointment

Your son's doctor can usually diagnose a retractile testicle. However, if there is any question about the diagnosis or need for immediate treatment, you might be referred to a doctor who specializes in urinary disorders and problems with male genitals in children (pediatric urologist).

Be prepared to answer the following questions on your child's behalf or to help him answer questions:

  • Were both testicles previously identified as descended in a well-baby or annual exam?
  • When did you notice the absence of the testicle in the scrotum?
  • Have you observed this before?
  • Has your child experienced any pain in his testicles or groin?
  • Has your son ever been treated for a hernia?
  • Has your son experienced any trauma to his genitals or groin?
Sept. 16, 2015
References
  1. Keys C, et al. Retractile testes: A review of the current literature. Journal of Pediatric Urology. 2012;8:2.
  2. Kliegman RM, et al., eds. Disorders and anomalies of the scrotal content. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Aug. 2, 2015.
  3. Cooper CS, et al. Undescended testes (cryptorchidism) in children: Clinical features and evaluation. http://www.uptodate.com/home. Accessed Aug. 2, 2015.
  4. Agarwal PK, et al. Retractile testis—Is it really a normal variant? Journal of Urology. 2006;175:1496.
  5. Gearhart JP, et al., eds. Cryptorchidism. In: Pediatric Urology. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com. Accessed Aug. 2, 2015.
  6. Hack WW, et al. Acquired undescended testis: Putting the pieces together. International Journal of Andrology. 2012;35:41.
  7. Stec AA, et al. Incidence of testicular ascent in boys with retractile testes. Journal of Urology. 2007;178:1722.
  8. Cooper CS, et al. Undescended testes (cryptorchidism) in children: Overview of management. http://www.uptodate.com/home. Accessed Aug. 2, 2015.
  9. Kolon TF, et al. Evaluation and treatment of cryptorchidism: AUA guideline. Journal of Urology. 2014;192:337.
  10. Granberg CF (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 2, 2015.